Medicare can seem confusing when you first look into how it works. The Medicare world has evolved to include different parts and plans. The first thing to grasp is that Medicare consists of two parts: Part A and Part B. You enroll in these two through the Social Security office. Medicare Part A provides coverage for your inpatient stay at medical facilities such as a hospital, hospice, or skilled nursing facility. Part B tends to be the main component of the two since it provides coverage for most of the medical services beneficiaries need. Let’s break down all you need to know about Medicare Part B. To learn more about Part B, visit Boomer Benefits – Part B.
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Signing up for Medicare Part B
Most people become eligible for Medicare when they turn 65. You will be automatically enrolled if you’ve been receiving Social Security benefits for at least four months before your 65th birthday month. If this is not the case, you will need to apply on your own either online, by phone, or in person at your local Social Security office.
Learning that Medicare Part B is not free might be a shock. A monthly premium is associated with it, and everyone must pay this to receive coverage. Most people pay the standard amount ($170.10 in 2022), but it could cost you more depending on your income. Before Part B covers anything, you must also pay an annual deductible ($233 in 2022).
What does Part B cover?
Medicare Part B provides coverage for your outpatient medical services. For example, doctor visits, ambulance rides, lab tests, and surgeries get covered by Part B. Injections or infused drugs you receive in a clinical setting should be covered by Part B as well.
Medicare Part B covers many preventive services as well, such as colonoscopies, mammograms, and flu shots.
Does Part B cover everything?
A critical piece of information to remember is Medicare Part B does not cover everything. Services covered under Part A, like your stay at a hospital, will fall under Part A. Part B does not cover the prescription drugs you pick up at a pharmacy either. You might have Part B coverage if, for example, you received an injection at your doctor’s office, but most retail prescription drugs fall under Medicare Part D.
Medicare does not cover any routine dental, vision, and hearing services, so you would want to consider a standalone plan that can help cover the cost of these services.
How much does Medicare pay?
Medicare Part B pays for 80% of the total cost of your Medicare-approved services.
How much do I have to pay?
Before Medicare pays its 80%, you will first satisfy the annual Part B deductible. Once Medicare pays its portion of your Part B services, the remaining 20% falls onto you. Unfortunately, there is no cap on your out-of-pocket spending, so the excess amount can quickly add up.
You also might have to pay something called excess charges. Excess charges occur when a healthcare provider accepts Medicare but does not accept their approved rate for a service, also known as Medicare Assignment. In this case, the provider can charge up to 15% more than what Medicare pays. Of course, the remaining charges must come out of your pocket.
We know this might sound scary, but as long as you receive your medical services from a facility or provider that accepts Medicare Assignment, you do not have to worry about excess charges.
Additional coverage
As stated earlier, the leftover 20% you’re responsible for can add up to quite a bit. Luckily, you can purchase additional coverage to help with your Medicare costs. There are two options for secondary coverage, a Medicare Supplement or a Medicare Advantage plan. These plans help lessen the out-of-pocket spending, so you aren’t overwhelmed with medical bills.
Getting started
Because Medicare Part B has a monthly premium, many seniors debate whether to enroll. The problem with this is if you do not enroll at the right time, you could face a lifelong penalty. This penalty will also continue to grow the longer you go without Part B. If you eventually do decide you need Part B, you will sadly have to add a penalty fee on top of your monthly premium before you can receive coverage.
Take the time to think about all factors before determining whether or not you need Part B. It’s important to think ahead and consider what your future self might need so that you won’t regret discarding this part of Medicare.
